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Published in: Annals of Surgical Oncology 6/2011

01-06-2011 | Bone and Soft Tissue Sarcomas

A Systematic Review and Meta-analysis of Intralesional Versus Wide Resection for Intramedullary Grade I Chondrosarcoma of the Extremities

Authors: Michael Hickey, MD, Forough Farrokhyar, PhD, Ben Deheshi, MD, FRCSC, Robert Turcotte, MD, FRCSC, Michelle Ghert, MD, FRCSC

Published in: Annals of Surgical Oncology | Issue 6/2011

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Abstract

Background

The surgical management of grade I intramedullary chondrosarcoma of bone remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of published data to determine the oncologic outcomes of intralesional versus wide resection for grade I intramedullary chondrosarcoma.

Methods

Literature searches were performed through Medline, EMBASE, and the Cochrane Database. Cohort studies in which one patient group with grade I chondrosarcoma underwent wide resection and one underwent intralesional curettage were included. Two reviewers independently assessed all eligible papers with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. The outcome measures were the pooled odds ratio and 95% confidence intervals for the risk of local recurrence and metastasis calculated through the random-effects method.

Results

Five eligible studies were identified including a total of 190 patients, 78 of whom underwent intralesional resection and 112 of whom underwent wide resection. Only one pelvic lesion was identified, which underwent wide resection. There were a total of five local recurrences and three metastases. The risk for local recurrence and metastasis did not differ significantly between the two groups, with an odds ratio for intralesional resection of 2.26 (95% confidence interval, 0.41–12.62) and 0.44 (95% confidence interval, 0.04–5.21) respectively.

Conclusions

Intralesional curettage as an alternative to wide resection for extrapelvic grade I chondrosarcoma of bone does not greatly increase the risk for local recurrence or metastasis. Overall effect estimates, however, should be interpreted with caution as a result of the relatively small number of events.
Literature
1.
go back to reference Giuffrida AY, Burgueno JE, Koniaris LG, et al. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91:1063–72.PubMedCrossRef Giuffrida AY, Burgueno JE, Koniaris LG, et al. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91:1063–72.PubMedCrossRef
2.
go back to reference Rizzo M, Ghert MA, Harrelson JM, Scully SP. Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res. 2001:224–33. Rizzo M, Ghert MA, Harrelson JM, Scully SP. Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res. 2001:224–33.
3.
go back to reference York JE, Berk RH, Fuller GN, et al. Chondrosarcoma of the spine: 1954 to 1997. J Neurosurg. 1999;90:73–8.PubMed York JE, Berk RH, Fuller GN, et al. Chondrosarcoma of the spine: 1954 to 1997. J Neurosurg. 1999;90:73–8.PubMed
4.
go back to reference Lee FY, Mankin HJ, Fondren G, et al. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999;81:326–38.PubMedCrossRef Lee FY, Mankin HJ, Fondren G, et al. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999;81:326–38.PubMedCrossRef
5.
go back to reference Riedel RF, Larrier N, Dodd L, et al. The clinical management of chondrosarcoma. Curr Treat Options Oncol. 2009;10:94–106.PubMedCrossRef Riedel RF, Larrier N, Dodd L, et al. The clinical management of chondrosarcoma. Curr Treat Options Oncol. 2009;10:94–106.PubMedCrossRef
6.
go back to reference Gelderblom H, Hogendoorn PC, Dijkstra SD, et al. The clinical approach towards chondrosarcoma. Oncologist. 2008;13:320–9.PubMedCrossRef Gelderblom H, Hogendoorn PC, Dijkstra SD, et al. The clinical approach towards chondrosarcoma. Oncologist. 2008;13:320–9.PubMedCrossRef
7.
go back to reference Weber K, Damron TA, Frassica FJ, Sim FH. Malignant bone tumors. Instr Course Lect. 2008;57:673–88.PubMed Weber K, Damron TA, Frassica FJ, Sim FH. Malignant bone tumors. Instr Course Lect. 2008;57:673–88.PubMed
8.
go back to reference Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–23. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–23.
9.
go back to reference Eefting D, Schrage YM, Geirnaerdt MJ, et al. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33:50–7.PubMedCrossRef Eefting D, Schrage YM, Geirnaerdt MJ, et al. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33:50–7.PubMedCrossRef
10.
go back to reference Welkerling H, Kratz S, Ewerbeck V, Delling G. A reproducible and simple grading system for classical chondrosarcomas. Analysis of 35 chondrosarcomas and 16 enchondromas with emphasis on recurrence rate and radiological and clinical data. Virchows Arch. 2003;443:725–33.PubMedCrossRef Welkerling H, Kratz S, Ewerbeck V, Delling G. A reproducible and simple grading system for classical chondrosarcomas. Analysis of 35 chondrosarcomas and 16 enchondromas with emphasis on recurrence rate and radiological and clinical data. Virchows Arch. 2003;443:725–33.PubMedCrossRef
11.
go back to reference Deloin X, Dumaine V, Biau D, et al. Pelvic chondrosarcomas: surgical treatment options. Rev Chir Orthop Traumatol. 2009;95:393–401. Deloin X, Dumaine V, Biau D, et al. Pelvic chondrosarcomas: surgical treatment options. Rev Chir Orthop Traumatol. 2009;95:393–401.
12.
go back to reference Donati D, El GA, Bertoni F, et al. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005;87:1527–30.PubMedCrossRef Donati D, El GA, Bertoni F, et al. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005;87:1527–30.PubMedCrossRef
13.
go back to reference Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001;83-A:1630–42.PubMed Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001;83-A:1630–42.PubMed
14.
go back to reference Sheth DS, Yasko AW, Johnson ME, et al. Chondrosarcoma of the pelvis. Prognostic factors for 67 patients treated with definitive surgery. Cancer. 1996;78:745–50.PubMedCrossRef Sheth DS, Yasko AW, Johnson ME, et al. Chondrosarcoma of the pelvis. Prognostic factors for 67 patients treated with definitive surgery. Cancer. 1996;78:745–50.PubMedCrossRef
15.
go back to reference Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol. 1998;24:120–6.PubMedCrossRef Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol. 1998;24:120–6.PubMedCrossRef
16.
go back to reference Mohler DG, Chiu R, McCall DA, Avedian RS. Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res. 2010;468:2765–73.PubMedCrossRef Mohler DG, Chiu R, McCall DA, Avedian RS. Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res. 2010;468:2765–73.PubMedCrossRef
17.
go back to reference Ahlmann ER, Menendez LR, Fedenko AN, Learch T. Influence of cryosurgery on treatment outcome of low-grade chondrosarcoma. Clin Orthop Relat Res. 2006;451:201–7.PubMedCrossRef Ahlmann ER, Menendez LR, Fedenko AN, Learch T. Influence of cryosurgery on treatment outcome of low-grade chondrosarcoma. Clin Orthop Relat Res. 2006;451:201–7.PubMedCrossRef
18.
go back to reference Souna BS, Belot N, Duval H, et al. No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res. 2010;468:1956–62.PubMedCrossRef Souna BS, Belot N, Duval H, et al. No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res. 2010;468:1956–62.PubMedCrossRef
19.
go back to reference Leerapun T, Hugate RR, Inwards CY, et al. Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res. 2007;463:166–72.PubMed Leerapun T, Hugate RR, Inwards CY, et al. Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res. 2007;463:166–72.PubMed
20.
go back to reference Etchebehere M, de Camargo OP, Croci AT, et al. Relationship between surgical procedure and outcome for patients with grade I chondrosarcomas. Clinics (Sao Paulo). 2005;60:121–6. Etchebehere M, de Camargo OP, Croci AT, et al. Relationship between surgical procedure and outcome for patients with grade I chondrosarcomas. Clinics (Sao Paulo). 2005;60:121–6.
21.
go back to reference Donati D, Colangeli S, Colangeli M, et al. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–9.PubMedCrossRef Donati D, Colangeli S, Colangeli M, et al. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–9.PubMedCrossRef
22.
go back to reference Bauer HC, Brosjo O, Kreicbergs A, Lindholm J. Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2–25 years. Acta Orthop Scand. 1995;66:283–8.PubMedCrossRef Bauer HC, Brosjo O, Kreicbergs A, Lindholm J. Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2–25 years. Acta Orthop Scand. 1995;66:283–8.PubMedCrossRef
23.
go back to reference Aarons C, Potter BK, Adams SC, et al. Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop Relat Res. 2009;467:2105–11.PubMedCrossRef Aarons C, Potter BK, Adams SC, et al. Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop Relat Res. 2009;467:2105–11.PubMedCrossRef
24.
go back to reference Cheng JC, Johnston JO. Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res. 1997; 338:205–14. Cheng JC, Johnston JO. Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res. 1997; 338:205–14.
25.
go back to reference Faisham WI, Zulmi W, Saim AH, Biswal BM. Pulmonary metastases of giant cell tumour of the bone. Med J Malaysia. 2004;59(Suppl F):78–81.PubMed Faisham WI, Zulmi W, Saim AH, Biswal BM. Pulmonary metastases of giant cell tumour of the bone. Med J Malaysia. 2004;59(Suppl F):78–81.PubMed
26.
go back to reference Kay RM, Eckardt JJ, Seeger LL, et al. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994;302:219–30. Kay RM, Eckardt JJ, Seeger LL, et al. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994;302:219–30.
27.
go back to reference Treadwell JR, Tregear SJ, Reston JT, Turkelson CM 2006 A system for rating the stability and strength of medical evidence. BMC Med Res Methodol. 6:52.PubMedCrossRef Treadwell JR, Tregear SJ, Reston JT, Turkelson CM 2006 A system for rating the stability and strength of medical evidence. BMC Med Res Methodol. 6:52.PubMedCrossRef
Metadata
Title
A Systematic Review and Meta-analysis of Intralesional Versus Wide Resection for Intramedullary Grade I Chondrosarcoma of the Extremities
Authors
Michael Hickey, MD
Forough Farrokhyar, PhD
Ben Deheshi, MD, FRCSC
Robert Turcotte, MD, FRCSC
Michelle Ghert, MD, FRCSC
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1532-z

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